It’s funny how numbers affect our perceptions. One of my favourite statistics to look at is that of shark attacks. A lot of people (including myself, before I started scuba-diving and actually coming into contact with these beautiful creatures) are frightened of swimming in the sea or in murky water for fear of sharks. Yet each year, there are roughly 60 recorded attacks by sharks on humans, of which between 4 and 10 are fatal. Statistically, your chances of being killed by a shark are roughly 1 in 250 million. Yet how we fear it! And look how much coverage a shark attack gets in the media- the death of a single surfer tends to go global.

By contrast, about 1.2 million people die annually and 50 million are injured in car accidents. But, other than make sure our safety belt is fastened, how often do you see people breaking out in a cold sweat, or experiencing rapid breathing, when they drive down to the store to buy some milk? How often do we see dramatic reporting of a car accident, unless it’s a multi-victim incident in our local paper?

Last week an earthquake ripped through Haiti’s capital Port-au-Prince. The latest estimates suggest 200,000 people may have been killed and 1.5 million left homeless. My organization has declared it a Category III, Level III response- our highest rating. It’s already being touted as being in the top ten most destructive earthquakes in history. Five million people or more are in some way impacted by the quake. In short, this is a massive event, comprable to the Boxing Day Tsunami of 2004.

Some more numbers. Right now, there are about 1,200 international search and rescue (SAR) technicians in a dozen or so teams sifting through the rubble to pull out survivors. Five days on from the quake, their pickings are pretty slim now. A few people were pulled out overnight. In all, since these international teams and their dogs and specialised equipment have arrived, it seems they’ve pulled out a little under a hundred people alive from the rubble. The various survivors who are pulled out alive now make the lead story for news outlets like CNN, and we learn their name, their situation, how long they were buried for. When the rescue efforts are unsuccessful, we hear about the specifics of the victim.

Boomerangblogger posted a thought-provoking message to an earlier post of mine in which he referenced the way in which the media portrays international rescuers as sifting through the rubble while Haitians watch on helplessly. It is, of course, a misrepresentation. In the hours after the quake, the 2 days before the international teams reached the ground, Haitians freed tens of thousands of their countryfolk- friends, neighbours, loved-ones and complete strangers. The rescuers’ stories won’t be told. The survivors’ names won’t get recorded.

It’s an interesting balance. We identify with the stories about individuals because they connect with us personally. We get details about a life and a situation in which we can see ourselves. We empathise. It can transform us. By contrast, hearing about two hundred thousand dead, or 1.5 million injured, the number is so huge that we have no experience to pin it on. What does two hundred thousand people even look like? A giant football stadium perhaps? But it’s hard to identify with. It numbs as. The famous quote misattributed to Josef Stalin claims “One death is a tragedy; a million is a statistic”.

I don’t want to knock international SAR teams. Every life saved is a win. Every person pulled alive from the rubble is tremendously valuable. SAR technicians give up their time, their families, and often risk their lives in dangerous places and in unstable structures to pull survivors to safety. I salute them for their efforts.

And these stories are important. They are the stories of hope that keep people engaged to the news media to balance out images of suffering. They are a flash of light, and they remind people that good work is being done, which encourages peoples’ generosity.

There’s a dark side of course. As boomerangblogger demonstrated, the fact that news media (arriving after the first 48 hours) cover stories of international teams but not of local Haitians digging skews our impression of what’s happening on the ground. We reinforce unhelpful stereotypes about the supremacy of foreign (usually Western) assistance over local strengths and coping mechanisms. We sideline the bravery and sacrifice of tens of thousands of earthquake survivors who risked their own lives to save others in huge numbers. Tens of thousands more people would lie dead under rubble were it not for these rescuers who pulled them out in the first few hours.

As well too, this focus on small numbers reinforces a myth about international SAR efforts. Experience shows that the quickest international SAR teams deployed into an emergency take 24-48 hours to get onto the ground- some even longer. In general, most disasters give you about 72 hours to get victims out, after which time almost everybody still buried will be dead (although in Haiti’s case, the gentle climate has extended this window by a day or two)- not very long once you take out the first 48 hours. Regardless, the small numbers speak for themselves. Dozens, perhaps a hundred lives saved. Each life valuable, unquestionably. But this is the pattern we see routinely following disasters. Small, high-profile and expensive SAR teams sent in from overseas, getting lots of media interest and generating a handful of success stories.

I don’t know what it costs to run an SAR team. Salaries, equipment costs, airlift costs, training costs and support costs, I imagine the bill for placing and keeping 1,200 SAR technicians in Port-au-Prince must run into the hundreds of thousands of dollars a day, at least. The value of a human life can’t be measured monetarily. However it’s important to understand opportunity cost.

An unknown number of injured Haitians will have died in the days immediately following the earthquake, through shock, exposure, and the onset of infection in open wounds. Deaths that could have been prevented by adequate medical care.

I’ve already talked about the barriers to assistance getting through to Port-au-Prince, a tragic reality. Hospitals were flattened, medical staff killed or injured. I’m not saying that had the money used for SAR teams been channeled into flying in highly trained medical teams and equipment instead, more lives could have been saved.

However I think it’s really important that we challenge the prevailing myth that spending huge amounts of money on high visible SAR teams is really what is most needed in the early days of a response. If, as is generally shown, SAR teams can only hit the ground after 48 hours, and are only saving a few dozen lives in any given reponse, is this a worthwhile use of funding? Should the media continue to carry such high-profile stories and continue to justify this as the best way forward in an emergency? Had an additional 1,200 medical staff and equipment been flown in to Port-au-Prince instead, how many people could they have treated, how many life-threatening wound infections treated, how many shock-managing IV drips inserted, in the last three or four days? Thousands? Tens of thousands?

It’s also important to reinforce the message that most lives are saved by locals in the minutes and hours immediately following a disaster. Their successes need to be praised- as much for the sense of pride and accomplishment of a nation in the aftermath of a disaster as anything. The public and donors need to be reminded that it is here, before a disaster strikes, where the real investment in preparedness pays off- not in expensive response teams, but in relatively simple interventions like community first aid training, basic search-and-rescue skills for villagers, simple training and techniques for surviving a disaster. If people can begin to understand that this is the real cutting edge of disaster relief, perhaps we can start seeing more and more money channeled into this sort of activity.

There’s a lot of what-ifs, and I don’t like playing that game. I stress again that I don’t have anything bad to say about the people who risk their lives on SAR teams or the work they do- they do great things and many of them are genuine heroes and heroines. But I do want people to understand that the impact of these foreign assistance teams is not perhaps as high as is often represented, and it’s important that we understand the opportunity-cost of sending in these high-profile teams over other forms of assistance.

Update 20.01.10:CNN reports that since the earthquake, 1,700 international SAR personnel in 43 teams have rescued 90 people in Haiti.

Update II- 20.01.10: Check out a very valid alternative perspective posted by aid logistician Michael Keizer on his blog A Humourless Lot, arguing that sending foreign SAR teams into a disaster zone gives them rare and valuable training and learning opportunities should disaster strike their own cities.

From Lisa: “I know. I’ve been thinking about this too. But, one of those 90 was someone on my personal g-mailing list, pulled out of the Hotel Montana after 50 hours.”

From Shelley: “I mostly agree with what your saying, the question I have is about the ‘good story / hope’ value that the SAR teams add.

I wonder how much extra money is donated when people see these stories and are touched in some way. I’m not sure that it would necessarily cover the costs of the … See MoreSARs, but if you then weight their cost against the lives they save (not that you can really do this as you’ve pointed out), the experience they gain and the money the ‘stories’ bring in….. maybe it evens out a tad more.

I completely disagree on the shark front, it doesn’t matter how rare, I still think of them every time I’m out in the surf.”

First, I’d guess that not all of the people in need of S&R after an earthquake are equally easy to find and rescue. In the immediate aftermath of the disaster, the people who are quickly rescued are probably also those who are more easily rescued, particularly since, when thousands of rescues are taking place, most of those rescues will be done by inexperienced amateurs, people digging out their friends, family and neighbors. So at the 48 hour mark, when the foreign S&R teams are coming in, the rescues left to be done will be those that are more technically difficult.

Second, there are certainly local expert S&R teams. They will be focusing on the more difficult rescues from the beginning, ideally called in when local ad-hoc S&R groups find a situation they can’t handle. But, being local to the disaster, they will be somewhat hampered in their actions. Some of the trained S&R people will be among the trapped, needing rescue rather than rescuing. Some or much of their equipment will be damaged by the disaster. The supplies they have will probably also be inadequate in quantity – not even the richest city in the world has enough rescue equipment to address S&R when a major city is devastated. And the supplies that they have will also be used up. They local S&R teams will also have their own concerns, about their own friends and family, which they are likely pushing aside as they deal with the immediate crisis.

Finally, by the time the first 48 hours are up, and foreign S&R teams can arrive, the local S&R teams are probably exhausted They will have been working day and night in those 48 hours. The work they’ve been doing will have been physically grueling. They may be weakened by hunger and thirst, suffering the same deprivations as the local civilians.

Hunger, thirst and exhaustion all weaken human judgment. So by the end of the first 48 hours, the local teams will be facing the most difficult and complected rescues, with depleted supplies, bodies pushed to their limit, and brains clouded with fatigue.

The point is not that people local to a disaster haven’t been rescuing people, but that they have, over and over. Two days, nonstop.

At the 48 hour mark, my guess is that the local professional S&R teams will be pushing the limits of their effectiveness, and need to rest, while the people still trapped will be reaching the end of their endurance, and can’t be left to wait while the local teams take a nap.

The foreign rescue teams are a gap-filler, between the limits of the local rescue teams and the point where rescue alive is no longer possible.

There is also an emotional necessity to bringing in more S&R, even when other types of aide are desperately needed. How well could other aide workers function, if they knew that people were trapped, local rescuers exhausted to collapse, and no one is left to do the last of the “digging out”? For both local and foreign aide workers, the decision to leave trapped people to die so that the effort can be made to help in other ways would be a difficult one. Knowing that the S&R is continuing eliminates that distraction.

Thanks for your detailed and thoughtful reply Ursula. I won’t respond to the entire message as I believe that for the most part you present a very valid argument, although I would still suggest that the value-add for this sort of investment versus the theoretical opportunity cost of inserting, for example, medical teams, needs further quantification. However your last paragraph is extremely convincing, and I agree- the thought of people trying to move on with other activities while ostensibly ‘ignoring’ people they know to be still trapped alive beneath buildings and left to die is a very relevant and important one. Thanks for adding your insight.

Thank you! I was pretty much speculating on the limits of local S&R, so I’m glad I wasn’t completely off-base.

I guess my point is that what needs to be measured is not merely the number of lives saved by local versus foreign S&R efforts, but rather the limits of local S&R, the window for saving lives by S&R, and the ways in which any gap can be addressed.

The relief work being done by foreign S&R teams is threefold, one is S&R for the people they rescue, the second is relief for the local S&R teams, while the third is to be a resource that helps keep people there to do other sorts of relief work from being diverted to S&R.

The calculation you discuss needs to be made, but I figure that all three types of relief provided by foreign S&R needs to go into the calculation.

I wonder for how many other disease or development related projects this is also the case? I can focus on hunger, comforted that someone else is handling malaria, who is in turn comforted by knowing I’m trying to get them fed. Is this a positive externality? Are different interventions complementary? Would you dare propose a study that could experimentally demonstrate it?

Good observation. It’s absolutely true across the development board- different sectors compliment each other and by hitting multiple sectors to produce the same aims (either yourself or by working with other partner organizations) you can increase the effectiveness of your own project- or vice versa, achieve nothing. Child survival (linked to your comment about) is an excellent example. When I was working in Niger during the 2005-6 ‘famine’ (actually and under-5 nutrition crisis), child survival rates were horrible. We began doing food distributions and targeted child-focused nutrition projects. In fact the array of contributing factors, all of which needed doing, included: Food shortages (combination of poor rains, locusts, aggressive market traders, and household power dynamics), lack of quality nutritious food (combination of growing practices and education), poor public health access (poor state infrastructure & investment in rural areas), poor disease control (malaria, diarrhoeal diseases- linked to both public health and water/sanitation resources and practices) and poor child-care practices (combination of maternal education and cultural norms). Missing any one of these factors meant that the impact of any one intervention was going to be diminished, and only focussing on one without making sure that you or a partner was focusing on another meant that your program would have been pretty much in vain.

HIV/AIDS and the interplay between medical support, clean water/hygeine and nutritious food to contribute to survival rates is another good example.